After medicine in the 20th century focused on healing the sick, now it is more and more focused on upgrading the healthy, which is a completely different project. And it’s a fundamentally different project in social and political terms, because whereas healing the sick is an egalitarian project […] upgrading is by definition an elitist project. […] This opens the possibility of creating huge gaps between the rich and the poor […]Many people say no, it will not happen, because we have the experience of the 20th century, that we had many medical advances, beginning with the rich or with the most advanced countries, and gradually they trickled down to everybody, and now everybody enjoys antibiotics or vaccinations or whatever. […]

There were peculiar reasons why medicine in the 20th century was egalitarian, why the discoveries trickled down to everybody. These unique conditions may not repeat themselves in the 21st century. […] When you look at the 20th century, it’s the era of the masses, mass politics, mass economics. Every human being has value, has political, economic, and military value. […] This goes back to the structures of the military and of the economy, where every human being is valuable as a soldier in the trenches and as a worker in the factory.

But in the 21st century, there is a good chance that most humans will lose, they are losing, their military and economic value. This is true for the military, it’s done, it’s over. The age of the masses is over. We are no longer in the First World War, where you take millions of soldiers, give each one a rifle and have them run forward. And the same thing perhaps is happening in the economy. Maybe the biggest question of 21st century economics is what will be the need in the economy for most people in the year 2050.

And once most people are no longer really necessary, for the military and for the economy, the idea that you will continue to have mass medicine is not so certain. Could be. It’s not a prophecy, but you should take very seriously the option that people will lose their military and economic value, and medicine will follow.